Brenda L. Gleason

Center for the Advancement of Pharmacy Education 2013 Educational Outcomes

An initiative of the Center for the Advancement of Pharmacy Education (formerly the Center for the Advancement of Pharmaceutical Education) (CAPE), the CAPE Educational Outcomes are intended to be the target toward which the evolving pharmacy curriculum should be aimed. Their development was guided by an advisory panel composed of educators and practitioners nominated for participation by practitioner organizations. CAPE 2013 represents the fourth iteration of the Educational Outcomes, preceded by CAPE 1992, CAPE 1998 and CAPE 2004 respectively. The CAPE 2013 Educational Outcomes were released at the AACP July 2013 Annual meeting and have been revised to include 4 broad domains, 15 subdomains, and example learning objectives.

An active-learning strategies primer for achieving ability-based educational outcomes

Active learning is an important component of pharmacy education. By engaging students in the learning process, they are better able to apply the knowledge they gain. This paper describes evidence supporting the use of active-learning strategies in pharmacy education and also offers strategies for implementing active learning in pharmacy curricula in the classroom and during pharmacy practice experiences.

Combination ACE Inhibitors and Angiotensin II Receptor Blockers for Hypertension

OBJECTIVE: To review data concerning combined angiotensin-converting enzyme (ACE) inhibitor and angiotensin II receptor blocker (ARB) therapy for hypertension. DATA SOURCES: MEDLINE (1966–April 2003), IPA (1970–April 2003), and EMBASE (1974–April 2003) with search terms of ACE inhibitor, angiotensin receptor blocker, essential hypertension, and combination therapy. DATA SYNTHESIS: ACE inhibitors provide incomplete blockade of the renin–angiotensin system, sometimes leading to loss of blood pressure control. Addition of ARBs may in theory further reduce blood pressure. Studies of combined ACE inhibitor and ARB therapy for managing hypertension were evaluated. CONCLUSIONS: While studies have shown statistically significant blood pressure reductions with ACE/ARB combination therapy, clinical significance is lacking. Further trials are needed before routine use of the combination can be recommended.

Dual Blockade of the Renin—Angiotensin System in Diabetic Nephropathy

OBJECTIVE: To review the literature concerning dual blockade of the renin—angiotensin system (RAS) with an angiotensin-converting enzyme (ACE) inhibitor and an angiotensin II receptor blocker (ARB) in diabetic nephrophathy. DATA SOURCES: MEDLINE (1998—September 2003), EMBASE (1998–September 2003), and International Pharmaceutical Abstracts (1998–September 2003) were used to access the literature. Search terms included angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, diabetic nephropathy, dual blockade, renin—angiotensin system, and combination therapy. DATA SYNTHESIS: Monotherapy with an ACE inhibitor provides incomplete blockade of the RAS. Dual blockade of the RAS has been studied in approximately 300 patients with diabetic nephropathy. Recent randomized controlled studies suggest that dual blockade using an ACE inhibitor and an ARB in diabetic nephropathy is well tolerated and will provide an additional 11–43% reduction in albuminuria versus monotherapy. CONCLUSIONS: Dual blockade of the RAS using an ACE inhibitor and an ARB provide statistically significant reductions in albuminuria and blood pressure. Use of dual blockade is safe, but requires additional monitoring for hyperkalemia. Long-term studies are needed to determine whether the decrease in albuminuria will correlate with an actual improvement from overt proteinuria to microalbuminuria or a decreased incidence of end-stage renal disease in the overall diabetic population.

Aspirin and Warfarin versus Aspirin Monotherapy after Myocardial Infarction

Objective To review data concerning combined aspirin/warfarin versus aspirin alone for secondary prevention after myocardial infarction (MI). Data Sources Literature was accessed through MEDLINE (1966–September 2002). Search terms included aspirin, warfarin, secondary prevention, and myocardial infarction. Data Synthesis Despite use of low-dose aspirin after an MI, risk of subsequent death and ischemic events remains high, making strategies for secondary prevention imperative. Relevant, large, long-term studies focusing on dual aspirin/warfarin versus aspirin alone in post-MI patients were evaluated. Conclusions Aspirin 75–325 mg/d should remain first-line therapy for secondary prevention after MI. Combining aspirin 75–81 mg with warfarin to maintain the international normalized ratio at 2.0–2.5 may provide added benefit, but should be considered only for patients at high risk for thromboembolic events.

Assessment of Students’ Critical-Thinking and Problem-Solving Abilities Across a 6-Year Doctor of Pharmacy Program

Objective. To determine the feasibility of using a validated set of assessment rubrics to assess students’ critical-thinking and problem-solving abilities across a doctor of pharmacy (PharmD) curriculum. Methods. Trained faculty assessors used validated rubrics to assess student work samples for critical-thinking and problem-solving abilities. Assessment scores were collected and analyzed to determine student achievement of these 2 ability outcomes across the curriculum. Feasibility of the process was evaluated in terms of time and resources used. Results. One hundred sixty-one samples were assessed for critical thinking, and 159 samples were assessed for problem-solving. Rubric scoring allowed assessors to evaluate four 5- to 7-page work samples per hour. The analysis indicated that overall critical-thinking scores improved over the curriculum. Although low yield for problem-solving samples precluded meaningful data analysis, it was informative for identifying potentially needed curricular improvements. Conclusions. Use of assessment rubrics for program ability outcomes was deemed authentic and feasible. Problem-solving was identified as a curricular area that may need improving. This assessment method has great potential to inform continuous quality improvement of a PharmD program.

Evolution of preprofessional pharmacy curricula.

Objectives. To examine changes in preprofessional pharmacy curricular requirements and trends, and determine rationales for and implications of modifications. Methods. Prerequisite curricular requirements compiled between 2006 and 2011 from all doctor of pharmacy (PharmD) programs approved by the Accreditation Council of Pharmacy Education were reviewed to ascertain trends over the past 5 years. An online survey was conducted of 20 programs that required either 3 years of prerequisite courses or a bachelor’s degree, and a random sample of 20 programs that required 2 years of prerequisites. Standardized telephone interviews were then conducted with representatives of 9 programs. Results. In 2006, 4 programs required 3 years of prerequisite courses and none required a bachelor’s degree; by 2011, these increased to 18 programs and 7 programs, respectively. Of 40 programs surveyed, responses were received from 28 (70%), 9 (32%) of which reported having increased the number of prerequisite courses since 2006. Reasons given for changes included desire to raise the level of academic achievement of students entering the PharmD program, desire to increase incoming student maturity, and desire to add clinical sciences and experiential coursework to the pharmacy curriculum. Some colleges and schools experienced a temporary decrease in applicants. Conclusions. The preprofessional curriculum continues to evolve, with many programs increasing the number of course prerequisites. The implications of increasing prerequisites were variable and included a perceived increase in maturity and quality of applicants and, for some schools, a temporary decrease in the number of applicants.

Validation of the entrustable professional activities for new pharmacy graduates

Purpose. The face validity of the core entrustable professional activities (EPAs) for new pharmacy graduates published by the American Association of Colleges of Pharmacy (AACP) in 2017 was evaluated. Methods. A 28‐item questionnaire was sent to experienced pharmacy practitioners affiliated with 4 schools of pharmacy. In addition to demographic information about education, training, credentials, and practice setting, participants were asked whether each EPA statement was pertinent to pharmacy practice and an expected activity that all pharmacists should be able to perform. Questions regarding the secondary attributes of the EPA statements examined whether each activity is observable, is measurable, is transferable to multiple practice settings, and integrates multiple competencies. Results. The questionnaire was distributed to 137 eligible participants, and 71 usable survey responses were received. Participants consistently agreed (≥75% agreement) that the 15 EPA statements for new pharmacy graduates describe activities that are pertinent to pharmacy practice and that pharmacists are expected to perform. A consistent level of agreement was observed regardless of the preceptors employment with a college or school, board certification status, or completion of postgraduate training, and no statistical differences in level of agreement were found based on these attributes. There was consistent agreement (≥60%) across geographic regions. No statistical differences in agreement were found between acute care practitioners and ambulatory care practitioners. Conclusion. A survey suggested that the core EPAs developed and vetted by AACP have face validity and are believed by experienced pharmacy preceptor‐practitioners to be pertinent to pharmacy practice and to describe activities that all pharmacists should be able to competently perform.